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Parity of cover in health insurance for orally and intravenously administered chemotherapy agents.

INTERIM STUDY REPORT
Insurance Committee
Rep. Charles Key, Chairman
Oklahoma House of Representatives
Interim Study 11-044, Rep. Gary Banz
September 13, 2011
Parity of cover in health insurance for orally and intravenously administered chemotherapy
agents.
Nadim Nimeh, MD, President
Oklahoma Society of Clinical Oncology
• In the last 5-10 years, there has been a significant shift from iv chemo therapy to oral
chemotherapy.
• 10-14 oral drugs are available to oncologists now for breast, lung, colon and prostate
cancers and leukemia, lymphoma and malignant melanoma.
• The benefits of oral chemo agents are extensive:
1. Patients don’t have to come to the office as frequently but can receive treatment in the
comfort of their own homes (With the iv correlate, patients must come to the office
and sit in a chemo chair for up to 3-4 hours. In the office, patients would also receive
iv fluids and aniti-nausea and possibly sedation medications.)
2. The chemotherapy is easier for the body to take in oral form because it is selective or
targeted, which can spare some of the negative effects on the organs.
• However, the price of the oral agents is almost totally prohibitive for some patients –
many cost $5,000-10,000 per month with some copays as high as $2,500 per month.
• Since cost prohibits some patients from obtaining the oral agents, they are not getting the
full benefit of treatment prescribed by physicians: 25 percent of patients delay taking the
treatment because of cost and 10 percent end up not taking the treatment at all.
• Now, the issue of price weighs on the physician’s mind when prescribing the treatment
instead of just considering what is best for the patient’s health.
• These oral chemo drugs, almost without exception, can extend the patients’ life and
quality of life.
• This is the future in the treatment of cancer. More will be coming.
Patrick Medina, OUHSC oncology pharmacist
Speaking on behalf of the Oklahoma State Oncology Association
Patrick-Medina@OUHSC.edu
• Oral chemo was first developed in the ‘60s, but there was always an iv equivalent so
physicians still had the option of giving the same drug in the office
• Since 2004, there are more than 10 targeted drugs with no iv equivalent, no alternative.
These are the category I or first choice of physicians for treatment
• Patient copay is often 20% of a $5,000 medication
• This problem is not going away: over 40 oral agents exist now, but it is predicted that 27
percent of all drugs that are going to be approved by the FDA for cancer will be oral
medications. Many will not have iv equivalents.
• In a cost effective analysis between oral and iv chemo drugs, oral drugs are almost
always found to be equivalent in cost or less costly than iv versions. This is not true for

INTERIM STUDY REPORT
Insurance Committee
Rep. Charles Key, Chairman
Oklahoma House of Representatives
Interim Study 11-044, Rep. Gary Banz
September 13, 2011
Parity of cover in health insurance for orally and intravenously administered chemotherapy
agents.
Nadim Nimeh, MD, President
Oklahoma Society of Clinical Oncology
• In the last 5-10 years, there has been a significant shift from iv chemo therapy to oral
chemotherapy.
• 10-14 oral drugs are available to oncologists now for breast, lung, colon and prostate
cancers and leukemia, lymphoma and malignant melanoma.
• The benefits of oral chemo agents are extensive:
1. Patients don’t have to come to the office as frequently but can receive treatment in the
comfort of their own homes (With the iv correlate, patients must come to the office
and sit in a chemo chair for up to 3-4 hours. In the office, patients would also receive
iv fluids and aniti-nausea and possibly sedation medications.)
2. The chemotherapy is easier for the body to take in oral form because it is selective or
targeted, which can spare some of the negative effects on the organs.
• However, the price of the oral agents is almost totally prohibitive for some patients –
many cost $5,000-10,000 per month with some copays as high as $2,500 per month.
• Since cost prohibits some patients from obtaining the oral agents, they are not getting the
full benefit of treatment prescribed by physicians: 25 percent of patients delay taking the
treatment because of cost and 10 percent end up not taking the treatment at all.
• Now, the issue of price weighs on the physician’s mind when prescribing the treatment
instead of just considering what is best for the patient’s health.
• These oral chemo drugs, almost without exception, can extend the patients’ life and
quality of life.
• This is the future in the treatment of cancer. More will be coming.
Patrick Medina, OUHSC oncology pharmacist
Speaking on behalf of the Oklahoma State Oncology Association
Patrick-Medina@OUHSC.edu
• Oral chemo was first developed in the ‘60s, but there was always an iv equivalent so
physicians still had the option of giving the same drug in the office
• Since 2004, there are more than 10 targeted drugs with no iv equivalent, no alternative.
These are the category I or first choice of physicians for treatment
• Patient copay is often 20% of a $5,000 medication
• This problem is not going away: over 40 oral agents exist now, but it is predicted that 27
percent of all drugs that are going to be approved by the FDA for cancer will be oral
medications. Many will not have iv equivalents.
• In a cost effective analysis between oral and iv chemo drugs, oral drugs are almost
always found to be equivalent in cost or less costly than iv versions. This is not true for